Trends and distribution patterns of infant mortality and maternal HIV positivity in South Africa: A decade review (2007 - 2016)
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i16b.1337Keywords:
infant mortality, maternal HIV, community survey, prevalence surveyAbstract
Background. The infant mortality rate (IMR) (24 per 1 000 live births) remains high in South Africa (SA), well above the recommended sustainable development goal (SDG) 3 of 12 deaths per 1 000 live births. High infant mortality is a poor indicator of the health of a population and will hamper attainment of the SDGs.
Objectives. To investigate the trends and distribution patterns of IMR between 2007 and 2016 and its association with HIV-positive pregnant mothers in SA.
Methods. This study used a cross-sectional study design by analysing secondary data on infant mortality from the 2007 and 2016 Statistics South Africa Community Surveys (CSs), as well as data from the 2007 National Antenatal Sentinel HIV and Syphilis Prevalence Survey. (Antenatal HIV Sentinel Survey – ANCHSS). Line charts with descriptive statistics were used to detail trends in IMRs, and multiple logistic regression models were used to identify risk factors for infant mortality in the 2007 and 2016 CS datasets. Spearman’s rank-order correlation (rho) was used to correlate infant mortality with data from the 2007 ANCHSS. All analyses were performed with Stata version 16.0.
Results. A total sample of 87 805, comprising 43 922 males and 43 883 females, was included in the analysis. The results revealed a decline in IMR from 55 deaths per 1 000 live births in 2007 to 32 in 2016. Overall, there was a significant decrease in the mortality rate from 2007 to 2016. The infant mortality proportions by province showed KwaZulu-Natal Province having the highest IMR (17.5 deaths per 1 000 live births in 2007 and 6.3 in 2016). Males had a higher IMR (28 deaths per 1 000 live births in 2007 and 17.7 in 2016) compared with females at 26.7 deaths per 1 000 live births in 2007 and 13.8 in 2016. IMR data from the 2007 CS was correlated with the 2007 ANCHSS (28% HIV prevalence in 2007), using Spearman’s rank-order correlation, which showed a moderate correlation of 0.58 (p<0.001).
Conclusions. The study findings showed a reduction in the trends of infant mortality between 2007 and 2016 in SA; despite the reduction, health inequalities persist. There is a correlation evident between maternal HIV prevalence and IMR in SA. We recommend the use of disability-adjusted life expectancy in SA to measure population health and introduce robust data sets that can better inform policy.
References
Sartorius BKD, Sartorius K, Chirwa TF, et al. Infant mortality in South Africa - distribution, associations and policy implications, 2007: An ecological spatial analysis. Int J Health Geographics 2011;10(1):61. https://doi.org/10.1186/1476-072X-10-61
Van der Spuy ZM. Millennium development goals - will we achieve these? Obstet Gynaecol Forum 2008;18(4):105.
Sharrow D, Hug L, You D, et al. Global, regional, and national trends in under-5 mortality between 1990 and 2019 with scenario-based projections until 2030: A systematic analysis by the UN Inter- agency Group for Child Mortality Estimation. Lancet Glob Health 2022;10(2):e195-e206. https://doi. org/10.1016/S2214-109X(21)00515-5
Khadka KB, Lieberman LS, Giedraitis V, et al. The socio-economic determinants of infant mortality in Nepal: Analysis of Nepal Demographic Health Survey, 2011. BMC Pediatrics 2015;15(1):152. https:// doi.org/10.1186/s12887-015-0468-7
Reidpath DD, Allotey P. Infant mortality rate as an indicator of population health. J Epidemiol Community Health 2003;57(5):344-346. https://doi.org/10.1136/jech.57.5.344
Romero Prieto J, Verhulst A, Guillot M. Estimating the infant mortality rate from DHS birth histories in the presence of age heaping. PLoS ONE 2021;16(11):e0259304. https://doi.org/10.1371/journal. pone.0259304
Mosley WH, Chen LC. An analytical framework for the study of child survival in developing countries. 1984. Bull World Health Organ 2003; 81(2):140-145.
Burgard SA, Treiman DJ. Trends and racial differences in infant mortality in South Africa. Soc Sci Med 2006;62(5):1126-1137. https://doi.org/10.1016/j.socscimed.2005.07.025
Rahman MM, Alam K, Khanam R. Socio-economic factors affecting high infant and child mortality rates in selected African countries: Does globalisation play any role? Globalisation Health 2022;18(1):69. https://doi.org/10.1186/s12992-022-00855-z
Bhardwaj S, Pattinson R, Kauchali S, et al. Implementation of strategies to improve programme effectiveness lead to an improvement in maternal and child health outcomes in South Africa. S Afr Med J 2017;108(3b):12812. https://doi.org/10.7196/SAMJ.2017.v108i3b.12812
Barron P, Pillay Y, Doherty T, et al. Eliminating mother-to-child HIV transmission in South Africa. Bull World Health Organ 2013;91(1):70-74.
Rhoda NR, Greenfield D, Muller M, et al. Experiences with perinatal death reviews in South Africa – the Perinatal Problem Identification Programme: Scaling up from programme to province to country. BJOG 2014;121(Suppl 4):160-166. https://doi.org/10.1111/1471-0528.12997
Statistics South Africa. Mid-year population estimates, 2017. Pretoria: Stats SA. P0302. https://www. statssa.gov.za/publications/P0302/P03022017.pdf (accessed 17 May 2024).
Statistics South Africa. Community Survey 2016 Technical Report. Pretoria: Stats SA, 2016.
Statistics South Africa. Community Survey 2007 Technical Report. Pretoria: Stats SA, 2007.
National Department of Health, South Africa. National Antenatal Sentinel HIV and Syphilis Prevalence
Survey 2007. Pretoria: NDoH, 2008. https://www.gov.za/sites/default/files/gcis_document/201409/
national-hiv-syphilis-prevalence-survey0.pdf (accessed 17 May 2024).
Pillay-van Wyk V, Dorrington RE, Bradshaw D. Rapidly changing mortality profiles in South Africa in
its nine provinces. S Afr Med J 2017;107:168-169. http://dx.doi.org/10.7196/samj.2017.v107i3.12344 18. Adetunji J. Trends in under-5 mortality rates and the HIV/AIDS epidemic. Bull World Health Organ
;78(10):1200-1206.
Bamford LJ, McKerrow NH, Barron P, et al. Child mortality in South Africa: Fewer deaths, but better
data are needed. S Afr Med J 2017;108(3b):12779. https://doi.org/10.7196/SAMJ.2017.v108i3b.12779
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